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enlarged cbd

Dilated common bile duct – ultrasound

Presentation

Epigastric abdominal pain for about 24 hours, associated with nausea and poor appetite. Previous history of gallstones.

Patient Data

Ultrasound (selected images)

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Dilatation of common bile duct seen in its entire extension that slightly tapers down at the head of the pancreas. Diameter measuring up to 1.5 cm. No choledocholithiasis. Ultrasound showing normal pancreas and mild ectasia of the main pancreatic duct (Wirsung > 2 mm). The characterization of the gallbladder was difficult on ultrasound, showing “wall-echo-shadow complex”.

CT Abdomen (selected image)

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CT without contrast demonstrates a 2.0 cm gallstone into the gallbladder and small focal calcification of its wall. It is also evident the previously shown dilatation of the bile duct.

Case Discussion

This patient had deranged liver function tests and ultrasound did not show an obstructive cause for the CBD dilatation (stone already eliminated?). Choledocholithiasis picture was felt most likely due to the acute presentation and known gallstones. The patient was further referred for ERCP (unfortunately the results are not available).

Another hypothesis for the obstruction is the possibility of a neoplastic lesion in the distal common bile duct/ampulla/pancreatic head, felt less likely on this clinical picture.

This patient had deranged liver function tests and ultrasound did not show an obstructive cause for the CBD dilatation (stone already eliminated?). Choledocholithiasis picture was felt most likely due to the acute presentation and known gallstone…